Design and Development of a Risk Classification Instrument for Virological Failure in HIV, Using Psychosocial Determinants of Health: Preliminary Evidence from a South American Country

Abstract

Predictive approaches in HIV to estimate a patient's risk to present with relevant health outcomes, such as hospitalizations and AIDS-related death, long before they happen, could be highly useful. We aimed to develop a risk classification instrument for virological failure through a scoring system that identifies patients with a low, medium, and high risk after six months of ART treatment. A case-control design was implemented through 355 HIV-positive Colombian adults who were assessed using the designed instrument. The variables with independent predictive values were selected using logistic regression analysis, and the diagnostic performance of the prediction score was evaluated using the area under the curve. The prediction score included relevant psychosocial and biological risk factors, some of them modifiable variables like substance use and low health literacy. The area under the curve value for the total prediction score was 0.85 (CI 0.80-0.90). Therefore, this instrument could be a valuable tool to identify at-risk patients of virological failure. In low and middle-income countries, the associated risk factors of virological failure are little known. Assessing such risk would lead to make individualized decisions regarding the patient's management and minimize the chance of non-desirable outcomes.

Keywords: HIV/AIDS; Prediction score; Risk management; South America; Virological failure.